<div class="table1">
	<br />
	<div class="table1">
		<br />
		<div class="option" align="center">{L_FEEDBACKNOTE}</div>
		<br /><br />
	</div>
	<br />
    <form method="post" action="{U_FORMACTION}" name="email_mod" id="email_mod" enctype="multipart/form-data" accept-charset="utf-8">
	<table border="0" cellpadding="3" cellspacing="1" width="100%" class="forumline">
		<tr>
			<td class="row1" width="150"><span class="gen"><label for="sender_name"><strong>{L_YOURNAME}:</strong></label></span></td>
			<td class="row2"><span class="genmed"><input type="text" name="sender_name" id="sender_name" value="{S_SENDERNAME}" size="30" maxlength="255" /></span></td>
		</tr>
		<tr>
			<td class="row1"><span class="gen"><label for="sender_email"><strong>{L_YOUREMAIL}:</strong></label></span></td>
			<td class="row2"><span class="genmed"><input type="text" name="sender_email" id="sender_email" value="{S_SENDEREMAIL}" size="30" maxlength="255" /></span></td>
		</tr>
		<!-- IF S_IS_ADMIN -->
		<tr>
			<td class="row1"><span class="gen"><label for="send_to"><strong>{L_SEND_TO}</strong></label></span></td>
			<td class="row2"><span class="genmed"><input type="text" name="send_to" id="send_to" size="30" maxlength="255" /></span> <span class="gensmall">({L_MVIEWADMIN})</span></td>
		</tr>
		<!-- ENDIF -->
		<tr>
			<td class="row1"><span class="gen"><label for="dept"><strong>{L_DEPT_SELECT}</strong></label></span></td>
			<td class="row2"><span class="genmed">{S_DEPT_SELECT}</span></td>
		</tr>
		<tr>
			<td class="row1" valign="top"><span class="gen"><label for="message"><strong>{L_MESSAGE}:</strong></label></span></td>
			<td class="row2"><span class="genmed">{S_BB}<textarea name="message" id="message" cols="63" rows="15">{S_MESSAGE}</textarea></span></td>
		</tr>
		<!-- IF SW_CAPTCHA -->
		<tr> 
			<td class="row1"><span class="gen">{L_SECURITYCODE}:</span></td>
			<td class="row2">{I_SECURITY_IMG}</td>
		</tr>
		<tr>
			<td class="row1"><span class="gen">{L_TYPESECCODE}:</span></td>
			<td class="row2"><input type="text" name="gfx_check" size="7" maxlength="6" /></td>
		</tr>
		<!-- ENDIF -->
		<tr>
			<td class="catbottom" colspan="2" align="center" height="28">
			<input type="hidden" name="opi" id="opi" value="ds" />
			<input type="submit" name="submit" id="submit" value="{L_SEND}" />	
			</td>
		</tr>	
	</table>
    </form>  
    
    <!-- IF S_SHOW_ALT -->
    <table border="0" cellpadding="3" cellspacing="1" width="100%" class="forumline">
		<tr>
			<th colspan="2" align="center">{L_ALT_INFO}</th>
		</tr>
		<!-- IF S_SHOW_MAIL -->
		<tr>
			<td class="row1" width="150" valign="middle" align="center"><span class="gen"><img src="{I_MAIL}" alt="" title="" border="0"><br /><b>{L_BYMAIL}</b></span></td>
			<td class="row2"><span class="genmed"><strong>{S_SITENAME}</strong><br/>{S_CAREOF}{S_ADDRESS1}<br />{S_ADDRESS2}{S_CITY}, {S_STATE}<br />{S_POSTAL}<br />{S_COUNTRY}</span></td>
		</tr>
		<!-- ENDIF -->
		<!-- IF S_SHOW_PHONE -->
		<tr>
			<td class="row1" width="150" valign="middle" align="center"><span class="gen"><img src="{I_PHONE}" alt="" title="" border="0"><br /><b>{L_BYPHONE}</b></span></td>
			<td class="row2"><span class="genmed">{S_PHONE1}{S_PHONE2}{S_TOLLFREE}{S_CELL}{S_PAGER}</span></td>
		</tr>
		<!-- ENDIF -->
		<!-- IF S_SHOW_FAX -->			
		<tr>
			<td class="row1" width="150" valign="middle" align="center"><span class="gen"><img src="{I_FAX}" alt="" title="" border="0"><br /><b>{L_BYFAX}</b></span></td>
			<td class="row2"><span class="genmed">{S_FAX1}{S_FAX2}</span></td>
		</tr>
		<!-- ENDIF -->
	</table>
	<!-- ENDIF -->
	<br />
</div>  